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Focusing on Medicaid Quality


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Sixty million Americans are getting their health care through a program that misspends more than $20 billion a year, that gives them access to only 7 out of 10 physicians, and that dramatically decreases their chance of surviving a major surgery. In a few years time, 26 million more people could be put into the program with almost no changes to the quality of care.

That health care program is Medicaid, the federal-state partnership that is supposed to be a safety net for low-income Americans. Medicaid is failing its beneficiaries, but instead of making it better, the federal government is set to make it bigger.

In 1965, Medicaid covered 4 million Americans, primarily children, the blind and disabled--people who had insurmountable obstacles to purchasing insurance. For decades, the program has been a lifeline for those with challenging health problems going through economically tough times.

Unfortunately, there are serious problems with the program. First, Medicaid typically pays doctors much less than the cost of providing care. That means that fewer doctors can afford to treat Medicaid patients or that they must strictly limit how many they can see. Only 70 percent of doctors accepted Medicaid patients in 2011.

Since there is already a general shortage of primary care physicians, many of those in Medicaid still have to resort to visiting the emergency room to receive basic care. A recent study found that Medicaid patients are twice as likely to visit the emergency room as those with private insurance. This isn't good for the patient and it's much more expensive.

Under Medicaid, getting care is difficult and the quality of care delivered is poor also. Only half of Medicaid participants receive good screenings for common forms of cancer--including breast cancer. When the University of Virginia looked at the likelihood of surviving surgery, they found that those on Medicaid are 97 percent more likely to die than those with private insurance. Astonishingly, this same study found that patients on Medicaid are 13 percent more likely to die than those with no insurance at all.

Medicaid patients aren't benefiting from new innovative treatments that would help them recover from heart attacks. Common therapies for coping with illness aren't being filtered to those on Medicaid.

The program is also facing major problems with waste and fraud. The Health Subcommittee has been looking into this problem and discussing the potential for bipartisan solutions. In recent years, Medicaid paid more than $21 billion in improper payments. Some of these payments are simply errors while others are going to outright criminals.

Simply put, Medicaid is ailing and its patients are the ones being hurt the most.

Instead of concentrating on fixing these big problems, the new health law simply expands the program to millions more Americans. Imagine, that you had an old pick up truck that could barely haul a load of bricks. Wouldn't you try to fix the truck up before you put even more bricks in the back? Medicaid is doing a poor job now, and adding more people to the program could make it even worse for current patients.

Expanding Medicaid has a significant cost for the federal government and for states. While Washington will cover most of the cost for the new enrollees, states will still see significant increases in administrative costs. For Pennsylvania, the first six years of the Medicaid expansion would cost around $2 billion.

For states that have to balance their budget, like Pennsylvania, this could mean cutting other priorities like transportation and education. The irony is that education itself goes a long way in helping people live healthier. Cutting education for health care programs wouldn't get us anywhere.

There is a better way. States are great innovators, but right now federal bureaucracy ties their hands. We should let the states have more freedom to innovate and provide for the specific needs of their citizens.

In order to help those just above Medicaid eligibility, we need to bring health care costs down. Unfortunately, the health care law is making insurance more expensive by adding new federal rules.

Medicaid isn't working, and making it bigger won't make it better. Helping those who rely on the program, especially the disabled, means focusing on quality over quantity.

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